REVISING PSYCHIATRY CHARTER DOCUMENT DSM-IV

A composition researcher and psychiatrist report findings from their 3 -year study of the revision of the most important book in the mental h ealth profession: the Diagnostic and Statistical Manual of Mental Diso rders (DSM-III). This 500-page diagnostic taxonomy defines some 250 me ntal disorders, and it functions for the field as a charter document, shaping the way mental illness is understood, treated, and studied. Th e revision project, which culminates in 1994 with the publication of D SM-IV, is a 6-year project involving some 1,000 psychiatrists and othe r mental health professionals. In this study the authors examine the D SM revision using three methodologies: in Part I they trace the histor y of the DSM classification system; in Part II they analyze published accounts of the revision by project leaders; and finally, in Part II t hey observed the revision process as it was actually carried out in on e of the 13 work groups. The authors conclude that the revision of DSM functions less to change the text than to achieve certain social and political effects. They find the revision works to further entrench th e biomedical model of mental disorder, to maintain the dominance of ps ychiatry within the mental health field, and to enhance the prestige o f psychiatry in relation to other medical specialties.